Abstract Background/Aims Osteoporosis-induced fragility fractures are a major cause of mortality and morbidity worldwide. In recent years, there have been important advances in the treatment of osteoporosis, including newer anabolic agents and updated treatment recommendations from the National Osteoporosis Guideline Group (NOGG). The 2022 NOGG guidelines recommended intravenous zoledronate as a first-line therapy, particularly post-hip fracture. However, there is little published data on how the prescribing of osteoporosis treatments has changed in recent years or whether this has influenced rates of fragility fractures at a national level. Methods We analysed aggregated data on all admissions to NHS hospitals in England with primary diagnoses of fragility-associated fractures (hip, pelvis, thoracic or lumbar vertebrae, distal radius or ulna, or proximal humerus) from April 2019 to February 2025. Secondary Care Medicines Data from all NHS hospitals in England were used to evaluate temporal trends in secondary care prescribing of zoledronic acid, denosumab, teriparatide and romosozumab over the same time period. As a comparator, English Prescribing Data were used to evaluate prescribing of alendronic acid in general practices in England. Results Hospitalisation rates for fragility fractures decreased by 3.63% between 2019 and 2025, from 2.48 to 2.39 fractures per 1,000 population. A sharp drop in fracture rates was observed during the first year of the pandemic (2.17 per 1,000 population), before returning to declining pre-pandemic trends. There was a 71.2% increase in the prescribing of intravenous/subcutaneous osteoporosis medications in secondary care from 2019 to 2025. The largest increase was seen for zoledronic acid, with a 161% increase in prescribing (from 21,430 to 55,873 patients), particularly from late 2023 onwards. Romosozumab prescribing has increased sharply since NICE approval in May 2022 (reaching 2,483 patients by 2025). During the study period, secondary care prescribing of denosumab increased by 25.6% (from 16,477 to 20,688 patients) and teriparatide prescribing increased by 52.1% (from 2,179 to 3,314 patients). Primary care prescribing of alendronic acid decreased by 11.9% over the study period (from 533,904 to 470,364 patients). Conclusion There has been a large increase in the prescribing of intravenous and subcutaneous osteoporosis treatments in England since 2019, particularly zoledronic acid, which has coincided with the introduction of the 2022 NOGG guideline update. Hospitalisation rates for fragility fractures have decreased modestly in England since 2019, with a notable drop in fracture hospitalisations observed during the first year of the pandemic. Disclosure Y. Lim: None. K. Biddle: None. M. Gibson: None. K. Bechman: None. J. Galloway: None. M.D. Russell: None.
Lim et al. (Wed,) studied this question.
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